Information sheet 2 N4G COMMITMENT
TO REDUCE CHILDHOOD STUNTING
Magnitude of the problem The Government of United Republic of Tanzania recognizes the gravity of childhood stunting to human development, particularly its largely irreversible effects including diminished cognitive and physical development, reduced productive capacity and poor health, and increased risk of diseases. The prevalence of stunting is significant across all regions in the country and over 2.5 million children are affected, with many more at risk. The overall magnitude of stunting at national level, estimated at 31.8% in 2018, is considered very high by WHO/UNICEF standards
MULTIPLE MEASURES TO REDUCE STUNTING To address the problem of stunting, the Government in collaboration with partners has formulated and implemented multiple interventions over the years including: ●
Development and implementation of the Tanzania National Strategy on Infant and Young Child Nutrition (MOH, 2004).
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Gradual integration of the requirements of Baby Friendly Hospital Initiative in health facilities and community-based support networks.
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Enacting legislation to protect appropriate infant and young child feeding practices including the regulation of marketing of breast milk substitutes and designated products, standards for hygienic practices for foods for infants and children, and maternity leave legislation to protect the breastfeeding rights on working women.
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Promotion of exclusive breastfeeding for the first six months of child development.
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Promotion of diversified dietary intake of complementary foods that is rich in micronutrients through supplementation, fortification, and dietary improvement.
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Interventions for improving the nutritional status of women of childbearing age and pregnant mothers.
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Promotion of family planning/SRH including increasing age at first birth and child spacing.
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Nutrition education including caring practices
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Greater empowerment of women with resources and decision-making powers within the households, communities and at national level.
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Increased investment in WASH including promotion of safe WASH practices and behaviours at household, community, and national level.
Achievements: signs of progress As a result of the political resolve against malnutrition and multiple interventions above, significant progress has been achieved:
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Stunting has shown a declining trend at national level over the years: from a national average of 49.7 % in 1991/92 to 31.8% in 2018.
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A significant decrease in the prevalence of stunting was registered in 8 regions between 2014 and 2018: Dodoma (from 45.2% to 37.2%), Morogoro (from 36.9% to 26.4%), Pwani (from 33.7% to 23.8%), Lindi (from 36.2% to 23.8%), Tabora (from 31.8% to 25.8%), Kagera (from 51.9% to 39.8%), Mwanza (from 34.2% to 26.2%), and Katavi (from 43.8% to 33.7%).
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Decline in infant and under five mortality rates -reflecting improvement in maternal and child nutrition, and control of infections exacerbated by low immuno deficiency due to poor nutrition-diarrhea, ARI, malaria, measles, and AIDS etc.
Outstanding challenges/bottlenecks
By 2018, 15 regions out of 26 were having levels of stunting considered to be “very high” i.e. exceeding 30% (Tanzania National Nutrition Survey 2018). See map below.
Inadequate infant feeding practices: only 58.6% of children 0-5 months are exclusively breast fed; only 35.6 of children 6-23 months receive minimum acceptable diet comprising of 4 or more food groups. ( TNNS 2018 )
Maternal malnutrition: there is a significant proportion of women in childbearing age experiencing micronutrient deficiencies which undermine their health status, capacity to produce healthy children and provide adequate care for the children and themselves.
Low quality of health care: many children do not have access to a package of quality health services that integrate prevention and management of child diseases with nutrition services.
Poor WASH environment and practices: A significant proportion of households do not have access to safe WASH facilities and hand washing with clean water and soap is not optimal
MAP:
STUNTING LEVELS BY REGIONS TANZANIA MAINLAND
SOURCE: TNNS 2018
Way forward: Sustaining and scaling up high impact interventions to reduce stunting The Government in collaboration with development partners has launched the second comprehensive National Multisectoral Nutrition Action Plan that prioritizes interventions for continued reduction of stunting over the next five years: ●
The government has made a strong impact commitment to reduce prevalence of stunting among children aged 0-59 months from 31.8 to 24% by 2026.
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The government, in collaboration with partners, is implementing key nutrition specific and sensitive interventions prioritized in the NMNAP II at a cost of TZS 165.2 billion (USD 71.8 million)
THE INTERVENTIONS INCLUDE: ● Protection, promotion, and supporting age-appropriate infant and young child feeding -Early initiation of breastfeeding within one hour of delivery, exclusive breastfeeding (0-5 months), timely introduction of adequate, safe and appropriate complementary feeding with continued breastfeeding up to 2 years.
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Prevention and treatment of wasting in children 6-59 months. Provision of micronutrient Supplementation-Vitamin A for children 6-59 months. Zinc treatment for diarrhea and deworming.
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Growth monitoring and promotion. Prevention and treatment of infectious diseases and quality care of sick child. Promotion of integration with immunization and other routine child health services. Promotion of handwashing with soap and improved water and sanitation practices. Capacity strengthening of healthcare workers on provision of nutrition services.
Implementation of interventions will be monitored under the NMNAP II Monitoring, Evaluation, Accountability and Learning (MEAL) framework, and progress reviewed periodically through multisectoral technical platforms/mechanisms including the annual Joint Multi-Sectoral Nutrition Review (J M N R )and the NMNAP II midterm review.